Provider Demographics
NPI:1922455104
Name:CASTILLO'S MD SERVICES, LLC
Entity Type:Organization
Organization Name:CASTILLO'S MD SERVICES, LLC
Other - Org Name:EDGARDO CASTILLO INTERNAL MEDICINE- ECIM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CEPEDA
Authorized Official - Suffix:
Authorized Official - Credentials:RMA
Authorized Official - Phone:239-240-3005
Mailing Address - Street 1:13500 TROIA DR
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-7304
Mailing Address - Country:US
Mailing Address - Phone:239-369-2749
Mailing Address - Fax:239-369-9158
Practice Address - Street 1:1530 LEE BLVD
Practice Address - Street 2:SUITTE 1600
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-4893
Practice Address - Country:US
Practice Address - Phone:239-369-2749
Practice Address - Fax:239-369-9158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-18
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1910600Medicaid
FLCX526ZOtherMEDICARE